Children at Increased Risk of Hypoxia

Attending AnesthesiologistThe Children’s HospitalClinical ProfessorDepartment of AnesthesiologyUniversity of Colorado Health Sciences CenterDenver, ColoradoTo the Editor:—The editorial by Benumof 1regarding preoxygenation cited pediatric patients as “obvious exclusion examples,” and suggesting that they were not candidates for preoxygenation before the induction of general anesthesia. On the contrary, neonates, infants, and children are at increased risk of hypoxemia because of smaller functional residual capacities, increased heart rates, and increased metabolic requirements compared with adults. The younger pediatric patient who presents for rapid sequence induction (e.g. , duodenal atresia) or suspected difficult intubation (e.g. , Pierre Robin anomalad) would certainly benefit from appropriate preoxygenation.Several studies using pulse oximetry data have confirmed that these young patients tend to desaturate more quickly than adults. 2,3Notably, the time to desaturation is affected by younger age 4and recent upper respiratory infection 5—a common variable encountered in clinical pediatric anesthesia from September through April.Such studies using oximetry 6,7and end-tidal oxygen assessment (“oxygraphy,” FeO2) 8,9have demonstrated that children do indeed benefit from appropriate preoxygenation, which prolongs the potential apneic interval, and that use of a tight-fitting mask for at least 1 min is both desirable and strongly recommended.